Viewer Question:

What are the complications and/or effects of taking antibiotics for a
life-long disease such as rosacea? Do the antibiotics become ineffective
and/or do you develop immunity to them?

Doctor's Response:

This is an important question
that raises several issues. First of all, it should be noted that any
potentially effective drug has possible side effects. In fact, no medication,
whether it is by prescription or available over the counter, should be utilized
without some consideration of the potential for toxic effects. Antibiotics, even
used for short periods of time, let alone for life-long therapy, raise the
issues of both toxicity and the emergence of bacterial antibiotic resistance.
(Bacterial antibiotic resistance means that the bacteria do not respond to the
antibiotic treatment.)

It is also important to note that antibiotics are frequently used in settings
where they will not provide any benefits. An example of this sort of
inappropriate use of antibiotics is for viral infections, such as the common
cold. In fact, there is a tendency for patients to believe that if they are ill
with an "infection", an antibiotic is the solution. Well, it's not
always.

In reality, inappropriately used antibiotics will do nothing except place the
patient at an unnecessary risk for potential side effects. In addition, too much
use of an antibiotic can cause bacteria to become increasingly antibiotic
resistant. Consequently, the resistant bacteria will not respond to the
antibiotic in the future when this therapy may truly be needed. Thus,
antibiotics should be used sparingly and with caution in all situations. If a
physician tells a person that an antibiotic is unlikely to be helpful, it is in
that person's best interest to not take the antibiotic.

With that said, there are clearly situations where antibiotics are necessary
to treat bacterial infections, such as of the lung (pneumonia), skin, or urinary
tract. In these settings, treatment should be initiated at the recommendation of
a physician and taken for a fixed duration of time (rarely more than 7-10 days).
If antibiotics are used with care, most individuals will not develop resistant
bacteria and therapy should be highly effective.

Furthermore, there are select situations, including certain severe
infections, where therapy must be given for prolonged periods of time. In these
cases, it is clear that the risk of not treating the infection outweighs the
potential for developing side effects and bacterial resistance. In very few
situations, however, is antibiotic therapy used for months or years.

In the case of rosacea, most cases can be managed with topical (applied to
the skin) antibiotics, such as topical metronidazole. (The pill form is much
less commonly needed.) Similarly, a severe form of acne (acne vulgaris)
occasionally requires oral tetracycline therapy, but most often can be
controlled with topical antibiotics such as metronidazole, clindamycin, or
erythromycin.

Whenever possible, topical therapies are preferred to pills, as they are less
likely to result in side effects or antibiotic resistance. Sometimes, however, a
condition is unresponsive (refractory) to topical treatment and responds to the
pill form of an antibiotic. In such a situation, the patient must decide, along
with her or his physician, whether the risks of ongoing therapy are outweighed
by the severity of the condition.